Healthcare Provider Details

I. General information

NPI: 1881919975
Provider Name (Legal Business Name): ELAINE B. JIVIDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASHLAND DR STE 301
ASHLAND KY
41101-7084
US

IV. Provider business mailing address

PO BOX 1447
ASHLAND KY
41105-1447
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-0322
  • Fax: 606-326-9809
Mailing address:
  • Phone: 606-326-0322
  • Fax: 606-326-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6411S
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: